I had Botox for TMJ and now I can barely smile. 6 days post op, is this permanent? (photos)

Question

I had botox because I clinch my jaws at night. The 6th day after I had it done I noticed my lip on my right side drooped a little when I smiled and by the next day I can barely smile and when I do it looks horrible. I have line by my mouth and look older than I did. Is this permanent?

Brent Moelleken, MD · Answer

Botox relaxes muscles, so it is possible that some of the muscles near the intended target muscles were inadvertently affected.  If it was a 'glancing blow' the effect should be less long lasting than if the muscles received a full dose.  Definitely let your doctor know so they can treat you appropriately.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry that your results became impacted by your Botox treatment. Rest assured that Botox is always reversible and you will return to your normal smile after 3-4 months.  I would review what took place with your injector so that adjustments can be made to avoid this in the future.

Jason Emer, MD · Answer

No, this isn't permanent. It takes 1-2 weeks for final results with Botox. Botox results resolve in 3-4 months. If you're unhappy with your final results, venus legacy treatments can give improvement. See an expert. Best, Dr. Emer

Samuel Shatkin, Jr., MD · Answer

When I inject patients with TMJ problems we target the Masseter Muscle which is the main muscle of mastication which adds pressure to the bite force contributing to force against the TMJ.  If you have some weakness of the smile muscles it is likely that the injections affected other muscles besides the masseters.  Over time, the effect of Botox will wear off.  Subsequent injections for TMJ placed deep into the masseter muscle shoule prevent this from happening.

Michael I. Echavez, MD · Answer

The change to your smile from the Botox you received for TMJ will not be permanent.  Your smile should gradually return to normal but it could take several weeks to a few months for this to occur.  In the future if you have Botox again for your TMJ, I would mention this issue with your smile to your injector.  Placing the injections differently can avoid this problem.

Peterson Pierre, MD · Answer

Based on your story and photos, this is most likely due to improper Botox placement. Fortunately, this is temporary as Botox typically wears off in 3-4 months.As with all cosmetic treatments, the skill of the doctor is of utmost importance. Don't trust your face to just anyone! Consult with an expert in facial aesthetics to maximize your results while minimizing side effects. You'll be happier and save money in the long run.

Kurt Kuhlman, DO · Answer

Your injector inadvertently injected some of the Botox into your smile muscles instead of the intended masseter muscle. Botox usually last 3-4 months when a full dose is injected. In your case a very small amount was probably injected into the wrong muscle, so you should have your normal smile back in a few weeks instead of a few months.

Nicholas Gentry, MD · Answer

Botox will wear off in about 3 months. I would see the provider to discuss options as well. Seeing someone in person and dynamically moving their muscles is very helpful.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your
photographs Donnalin. I understand your concern. Botox is a purified protein
used to address wrinkles associated with facial expression. When injected into
the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The
most common areas of treatment are in the upper face. These include the
horizontal lines seen on the upper forehead when one raises the brows, the
vertical lines seen between the brows when one frowns (frown lines), and the
crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without
knowing the dose used and placement of the product. However, I hope the information
provided here is useful.While Botox is most commonly used in the upper face, it can be placed in the masseter muscle in
the lower face to contour the lower face and address pain associated with TMJ.
In this area 20-40 units of Botox are used per side. Depending on the reason
for the enlargement of the muscle, permanent results may be achieved. For
example, some people have a habit of grinding, clenching, or biting their teeth
subconsciously. Often times this happens in their sleep when they are not aware
of it. Botox placed in this muscle will relax the muscle and the grinding, clenching,
and/or biting will decrease. This will reduce the size of the muscle. If the
brain gets accustomed to this and the person stops grinding, clenching, or
biting, then the muscle will not become enlarged or as enlarged again. However,
if the habit starts again, the muscle will likely get larger.With any injection, there are risks such as
pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take
special precautions to minimize these risks such as using a painless technique.
We also treat bruises with a laser as early as the next day. Bruises usually
resolve within two weeks if untreated. After a laser treatment bruises usually
resolve in 1-3 days, but may still take two weeks for full resolution. In
addition to these risks, with Botox there is also a risk that the product spreads
or diffuses to nearby structures. Spread to nearby muscles can lead to side
effects such as the temporary appearance of droopy eyelids or a temporary
asymmetric smile.In the lower face, the zygomaticus muscles are close to the masseter muscle. The zygomaticus muscles are responsible for pulling up on the corners of the mouth when one smiles. If Botox spreads from the masseter to
the zygomaticus muscles and relaxes these muscles it can lead to the appearance of an asymmetric
smile where the corners of the mouth are not pulled up. I recommend that my
patients just wait as the effects go away on their own. This side effect
resolves on its own in 2 weeks to 4 months, depending on the severity.After a Botox treatment, I recommend that my
patients avoid heat exposure, alcohol consumption, and strenuous exercise for
24 hours and not lie down flat for four hours. This is because all of these
activities may possibly lead to the movement of the product and consequent side
effects such as droopy eyelids as described above. Although there have been no
definitive studies shown that these actually occur and some physicians do not
provide such aftercare instructions, in the absence of data I err on the side
of caution and recommend that my patients avoid such activities.Please consult with a doctor for specific
recommendations. Good luck!

Melvin Elson, MD · Answer

All effects of Botox are temporary so dont worry this will fade It occurred because there are 2 methods used to treat the masseter--5 siites and 3 sites. When the 5 sites are injected there are injections close to the muscles adjacent to the mouth and this occurs so next time ask about not gettting the medial injections but only the 3 sites which is still effective for tmj

I had Botox for TMJ and now I can barely smile. 6 days post op, is this permanent? (photos)

Answers (13)

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